MEDICARE: TRACY D BRADY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD60945861	WA
2	207Q00000X	Family Medicine Physician	4301088426	MI
3	207R00000X	Internal Medicine Physician	ME154970	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528210838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY D BRADY M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	508-627-6048
Fax Number	:	850-862-8156

Provider Business Practice Location Address
First Line	:	203 CLOVERDALE BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1405
Country	:	US
Telephone Number	:	850-862-7604
Fax Number	:	850-862-8156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	05/03/2022

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Directions to “ TRACY D BRADY M.D.” Practice Location

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